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Copper and Magnetic Bracelets for Arthritis

A recent study published in the journal Complementary Therapies in Medicine shows no benefit from copper or magnetic bracelets for symptomatic treatment of arthritis. While this is a relatively small study, it highlights the lack of evidence to support this billion dollar plus industry.

The study is a double-blind, controlled crossover study involving 45 subjects with osteroarthritis. Each subject wore one of four bracelets – copper, two types of magnetic bracelet, and one demagnetized, in random order each for 16 weeks. It showed no difference among the four groups.

This is only the second published controlled trial looking at copper bracelets for arthritis. The first is from 1976 and showed some benefit. Then there are no published studies (just reviews and comments) for the next 33 years, until this current study.

There have been a number of studies of magnetic bracelets. These are more difficult to interpret – the primary problem with these studies is that it is very difficult to properly blind subjects. It is simply too easy to discover if a bracelet or other magnetic device is actually magnetic. You can partially mitigate this problem by using devices of various magnetic strengths, but even then patients may have an easier time detecting the stronger magnets.

One study found that magnetic bracelets correlated with improved symptoms from hip and knee osteoarthritis. The authors concluded:

“It is uncertain whether this response is due to specific or non-specific (placebo) effects.”

Uncertain indeed. What this study actually shows is how difficult it is to eliminate placebo effects from these studies. There is almost no plausibility to magnetic bracelets improving knee arthritis – the bracelets are simply too remote. None of the hypothesized mechanisms by which static magnets might work have panned out – they do not influence blood flow or inflammation. Most static magnets do not even penetrate to the target tissue, and in this case the magnets are no where near the target tissue.

Studies that use magnetic braces and wraps are also problematic because the braces and wraps themselves can have significant benefit.

A recent systematic review of static magnets to treat pain concluded:

The evidence does not support the use of static magnets for pain relief, and therefore magnets cannot be recommended as an effective treatment. For osteoarthritis, the evidence is insufficient to exclude a clinically important benefit, which creates an opportunity for further investigation.

Consumers using such products are prey to all of these placebo effects, in addition to others, such as regression to the mean. Arthritis, like many illnesses, waxes and wanes. People are likely to seek treatments when their symptoms are bad, and statistically likely to improve to a more average severity. This regression to mean severity is easily interpreted as a response to whatever treatment they initiated when their symptoms were at their worst.

So what we have is a series of implausible claims, negative or insufficient evidence, and a clinical setting where self-deception is likely. This adds up to over a billion dollars of wasted health care dollars.

We have to confront the fact that this is what has and will happen in the absence of adequate regulation – the public will waste money on useless therapies, their attention and resourcesy may be diverted from more effective interventions, and some unscientific interventions may be directly harmful.

There is also no incentive for industry to spend time and money doing quality studies when they don’t have to. Sellers of copper bracelets were happy to do so for decades without studying their claims.

Further, most new health claims are going to turn out to be false. The lower the prior probability (by definition) the more likely the claims are to be false. So accross the board there is a great deal of risk and expense to products with untested or dubious health claims, and very little benefit.

Posted in: Science and Medicine

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62 thoughts on “Copper and Magnetic Bracelets for Arthritis

  1. FelixO says:

    The study author has an additional, similar, study on rheumatoid arthritis which is, I believe, awaiting publication.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556642/

  2. tarran says:

    A couple of quibbles about the economic arguments:

    1) Regulation causes dead weight losses. Sometimes these losses are worth the benefits they create, sometimes they are not.

    2) Rarely is there such a thing as a “unregulated” market: although quack cures are pretty close to it. Even in the absence of state regulation, there will be regulation; for example. nobody forces the makers of the copper bracelets to make them comfortable to wear. The makers add significantly to their production costs to remove burrs and to machine them into a comfortable shape. The ultimate regulator is consumer preference and unfortunately consumers prefer an innefective bracelet to nothing.

    3) State regulation is often far worse than non-state regulation: compare the track record of UL and Consumers’ Union to the FDA, the NTSB etc. All regulatory agencies must please their donors. For state regulators that means pleasing politicians. For UL that means pleasing insurance companies and also manufacturers. For consumers’ Union, debendent on funding from millions of subscribers, that means religiously guarding their reputation for impartiality. Note, that if UL makes garbage recommendations, the insurance companies suffer increased losses. Similarly if Consumers’ Union ever gets caught in an act of corruption, it can be permanently put out of business, like Arthur Andersen did when it was nailed for helping Enron cook the books. Governmental regulators face no such backlash: note that while Artur Andersen went bankrupt because their actions in Enron led to a loss of confidence in their audits, the SEC still continues to be funded despite their public failures.

    4) Industry does face an incentive to do studies, The consultancy industry (companies like Tiax) has tens of billions of dollars pumped into it by companies trying to do basic research to come up with new products that will give them an edgein the marketplace. My dad, for example, is a physicist who does basic research hat is primarily funded by private companies looking to come up with new products.

    5) Which leads me to the most important point: the existance of the arthritist bracelet market is good; it signals to entrepeneurs/inventors/researchers a large unmet need. They don’t have to guess the size of this underserved market; they know what it is form the sales figures of the quack companies. The quack companies have created an effective sales and distribution system that does not have to be recreated. In effect, the industry has done most of the hard work in getting a product out the door. Anybody who invents a product that actually works can coopt the existing marketing and distribution channels rather than having to recreate them.

    Thus, if you invent a bracelet that cures arthritis and want to sell it, you can now more easily get capital funding, more easily get your product out to customers than you could if the indsutry was outlawed.

    The solution to the problem is not to outlaw the quack cure industry, but rather to focus your energies on providing goods and services that provide more bang per buck for consumers.

  3. tarran – you are giving a very theoretical argument to a situation for which we have a ton of empirical evidence – evidence that directly contradicts your arguments.

    We have 15 years of DSHEA in this country. This has not led to any of the alleged benefits you cite. Instead we have a nearly unregulated supplement market, and nearly unregulated market for medical devices (as long as you stay within the ridiculously large and easily exploited “structure and function” arena) – which has demonstrably resulted in a multi-billion dollar industry that provides useless or harmful products to the public. They are not only wasteful, they often take resources away from better products and services. Industry has not stepped up and done good research. Consumer protection organizations have not filled the gap (at least not significantly).

    The problem is that health outcomes are too complex for anecdotal perceptions to be a reliable guide. Consumer choices are driven by anecdotes and testimonials – which are bad indicators of actual quality (unlike, say, the comfort of a bracelet). Companies have no incentive to do the kind of quality research that could falsify their advertising claims.

    In short, for health care claims the free market does not work. You need systematic quality control. This does not have to mean only government regulation – there are also academic and professional mechanisms for quality control.

    This experiment has been replicated throughout the world. Show me a case where free market forces stemmed medical quackery, and even if you can for every one there must be hundreds or thousands of counter examples.

  4. tarran says:

    Dr Novella,

    Unfortunately, I will not be able to answer you in a way that satisfies you, even though I disagree with most of your assertions. I think it will take months of research to adequately respond, months which I don’t have – I am battling a ton of deadlines right now.

    We have 15 years of DSHEA in this country. This has not led to any of the alleged benefits you cite.

    I disagree:
    1) It has provided entrepreneurs with a properly structured mature market to deliver working cures for when one should finally be developed.

    2) There is nascent private regulation: This blog for example. The venom and vituperation that quacks direct at you is, I think, ample evidence that you are having an effect on informing consumers.

    They are not only wasteful, they often take resources away from better products and services.

    What better products and services? If there is one that is more satisfactory to consumers that is not making it to market, I would like to talk to you: we could make a killing taking over the market from the quacks.

    Industry has not stepped up and done good research. Consumer protection organizations have not filled the gap (at least not significantly).

    I would argue that is the effect of the high taxes levied on businesses and the use of those taxes to fund a large federally controlled research apparatus. The manner in which publicly funded institutions crowd out private institutions they compete with, even when the public institution is less efficient has been amply demonsrated in numerous other sectors of the economy.

    The problem is that health outcomes are too complex for anecdotal perceptions to be a reliable guide. Consumer choices are driven by anecdotes and testimonials – which are bad indicators of actual quality (unlike, say, the comfort of a bracelet).

    I completely agree with this. I think, honestly, that this will continue to be an issue until surefire cures are demonstrated, rather than ones that are statistically more likely to work than not.

    Companies have no incentive to do the kind of quality research that could falsify their advertising claims.

    True but competitors seeking to enter the field are the ones with the incentive to do the research that dethrones the existing players. What you are describing is a cartel that is abusing consumers. Tomas Dilorenzo did a study of cartels that pretty comprehensively reviewed every cartel that arose during/post industrialization in various economies. He found that absent government support no cartel was able to abuse consumers for any long period of time: the incentive to cheat and take market share by better serving customers is too high for existing members of the cartel/newcomers.

    In short, for health care claims the free market does not work.

    Umm what?

    You need systematic quality control. This does not have to mean only government regulation – there are also academic and professional mechanisms for quality control.

    The latter two are part of the free market. Perhaps we are using different definitions. The definition advanced by Dr Ludwig von Mises which is used by most -but not all – economists is that
    “The free market describes the matrix of transactions that take place in the absence of coercion that the actors expect Will benefit them ex-ante”
    Thus, when you publish this website and I read it, we are engaging in a free market transaction even though no money changes hands.

    Show me a case where free market forces stemmed medical quackery, and even if you can for every one there must be hundreds or thousands of counter examples.

    This is what would take lots of research to examine: throughout human history, the market for medical services has been pretty much the most regulated one. My gut instinct would be to look at Medieval Iceland, which was about as close to a laissez faire economy as we can find in history and do a comparative study to other Viking societies that were similar culturally but had kings running the show. Otherwise we would get into a pretty much unresolvable argument as to whether the benefit was due to the relative freedom or the state regulations in place.

    With that being said, I don’t see the medical industry as being special. In fact, I would challenge you to explain the mechanism that makes the medical industry be so different from everything else.

    The medical industry is like any other industry where providers provide a service to consumers that consumers poorly understand. And when one expands one’s view to include those industries, one finds that state-based regulation is far worse than market-based regulation; the state is too easily coopted to use regulation to help special interests plunder consumers.

    In the end, I think your argument boils down to three main objections:
    1) The changes that I argue will happen haven’t happened in the past ten years
    2) The changes that I argue will happen due to market forces won’t happen because of lack of incentives.
    3) Consumers have difficulty in judging which treatments are better.

    My response boils down to three counters and one agreement:
    1) I don’t know whether it will take 5 minutes or 50,000 years for better products to hit the market. My argument is that once they exist they will come to dominate the market.

    2) You and I are using different definitions of the free market. Mine is a praxeological one that includes all non-coerced transactions. I presume that yours is likely to only include transactions where one party trades a good or service for more money than they spend in creating it.

    3) You are, in effect, positing that a cartel can survive in a free market, and that the incentives favor sticking with the cartel rather than cheating on it by providing a better service to customers. My argument is that that is not the case, a cartel that is providing inferior products at higher prices than is theoretically possible provides “cheaters” within the cartel and prospective new upstart competitors an opportunity to enter the market. The history of economics is legion with examples of cartels that failed because of such cheating.

    4) I agree that consumers are making poor choices. However, that will change once people start inventing sure-fire treatments rather than treatments that are statistically likely to be beneficial.

    I know that you will consider this argument to be overly theoretical, but its the best I can do with the limited time available to respond. I also want to apologize if I used any medical terminology incorrectly, my expertise is not in medicine but in physics, software and economics :).

  5. tarran, I think that the position that a completely unrelegated free market always naturally leads to the the best outcome is observably false. Also false is the assumption that consumers always behave rationally in either the short term or the long term.

  6. Harriet Hall says:

    The free market is very effective in giving people what they think they want, not what they need or what is good for them.

  7. I won’t say I disagree, Harriet, but I wouldn’t have phrased it that way. I suppose you’re so used to your words being misinterpreted and quoted out of context to set straw men ablaze that you don’t worry too much about it.

    Countdown to a comment where someone claims Harriet is an anti-American communist in 3….2….1….

  8. David Gorski says:

    But, Harriet, you must know that human beings are perfectly logical operators who always know what their own self-interest is. As for those who don’t, screw ‘em. Ayn Rand told us so. :-)

  9. weing says:

    “The free market is very effective in giving people what they think they want, not what they need or what is good for them.”

    While I agree with that statement, some people would say what makes their lives worthwhile are the things that they want and not need. I thought we were getting away from paternalism. I tell my patients that my job is to give them reliable information and their job is to decide what to do with it.

  10. Harriet Hall says:

    The free market, like democracy, is the worst possible system… except for all the others.

  11. David Gorski says:

    Actually, I used to be a fairly hard core laissez-faire type, politically, but I’ve come to realize that there needs to be a balance between the free market and regulation. Too far in either direction, and bad things happen. The most difficult question, of course, is finding that “sweet spot.”

  12. Scott says:

    tarran,

    The fundamental problem with a free market in health care is insufficient information. Consumers do not possess (and are unable to obtain) adequate information to assess the efficacy of various offered treatments. Therefore, there is little to no competitive advantage to offering treatments that DO work. And given the costs involved in developing and proving an effective treatment (which may be entirely discarded if one is a quack), there is in fact a massive competitive DISadvantage.

    Providing sufficient information for consumers to make fully informed decisions is not feasible; it simply takes too much time and expertise to sort through it. (In other words, the costs to the consumer of selecting the best treatment would be excessive.) There’s also the fact that quacks spend a great deal of time, money, and effort promoting the fiction that their snake oil works – massively degrading the impact of the actual quality information available.

    If you’ve got a solution to this problem OTHER than government regulation, I’d love to hear about it. Ultimately, free markets can only work properly when the consumers are informed. When it comes to health care, they are not, and can not, be so informed, leading to market failure.

  13. Taran:

    1) promising future benefits that have never been demonstrated is a very weak argument. Meanwhile, there are demonstrable significant downsides to unregulated health claims

    2)I don’t think we are using different definitions. You misunderstand what I meant by academic and professional mechanisms. This website does not count. I am talking about not getting privileges at a hospital, or getting certified by a professional organization (which can be tied to privileges). I am also talking about self-policing, which does often require the state licensing board to have teeth. My only point was that the government is not the only form of quality control, and quality control is not incompatible with a partially free market – you need a balance.

    3) Your response here is just a non sequitur. The point is that quality of service and products is not obvious in medicine, and it is simply impossible to know, except through statistical analysis, what really works and is safe. Consumers have a very flawed and hazy perception of the value of the health care products they buy.

    Market forces select for dramatic claims and promises, not for actual value. Also, the sicker someone is, the more likely they are to be desperate and vulnerable. This relates to the next point:

    4) So – the quack claims will go away when we have completely cured everything? This may be true – but it’s irrelevant. We will likely never cure everything, if we do it is far enough in the future not to worry about, and when/if we do this entire argument will be irrelevant.

    So far it seems like there will always be new diseases and illnesses that are imperfectly treated. There has always been a vast gray zone of sub-optimally treated conditions. This is where the quacks prey. This is where regulation is most needed, to prevent exploitation and fraud.

    Keep in mind – I am a strong advocate of the power of free markets. But we need balance, and when it comes to health care the notion that free markets will magically work everything out, but the guvment is off everyone’s back, is truly wishful thinking.

  14. weing says:

    Is it a free market if the quack’s advertising convinces a victim of the need and efficacy of his/her quack therapy? The quack relies on the victim not being fully informed. Then the victim wants the treatment and the quack provides the service in a “free market”.

  15. “Is it a free market if the quack’s advertising convinces a victim of the need and efficacy of his/her quack therapy? The quack relies on the victim not being fully informed. Then the victim wants the treatment and the quack provides the service in a “free market”.”

    Indeed. Most economic theories that taut the absolute effectiveness of a totally free market rely on the assumption of information efficiency where quality information somehow bubbles to the top to crowd out bad/ inaccurate information which often doesn’t happen in reality.

    Frankly the effective basis of marketing tends to be to distort information to create perceived value. Why does anyone buy brand name canned vegetables instead of store brand when they both probably rolled of the same production line at the same plant? -perceived value not necessarily supported by facts.

  16. pmoran says:

    There is a case for some laissez faire with harmless products.

    Patients whose arthritis needs, including the soothing of the “do something!” compulsion when the joints are playing up, are helped by copper bracelets may not be quite so exposed to the potential risks and expense of NSAIDs, or of laparoscopic knee debridements, or of hip replacements, or of numerous other “alternative” arthritis products with unknown risks.

    This is not an outlandish proposition. It is even testable, but not by the usual placebo-controlled study. I am not suggesting that it is worthy of study, merely that we should factor in any such uncertainties when pronouncing on “what should be done”.

  17. Harriet Hall says:

    I don’t see any problem with selling these things. I only object to making claims for them that are not supported by the evidence.

  18. tarran says:

    Dr Novella,

    First, I would like to thank you for taking the time out of what I am sure is a busy day to write a rebuttal to my comment. I really enjoyed reading it. I also think we agree on far more than we disagree, even though it leads us to hold oppositional positions on certain political questions.

    In order to defend my position, I am going to take your comments out of order. I apologize in advance if I fail to address or acknowledge something.

    You misunderstand what I meant by academic and professional mechanisms. I am talking about not getting privileges at a hospital, or getting certified by a professional organization (which can be tied to privileges). I am also talking about self-policing, which does often require the state licensing board to have teeth. My only point was that the government is not the only form of quality control, and quality control is not incompatible with a partially free market – you need a balance.

    Yes, but in the absence of such coercion, they are free market mechanisms. Please note, a hospital refusing to give admitting privileges to a doctor is not coercive; a hospital is free to pick and choose who it does business with.

    I will take up the “teeth” issue a little later.

    Your response here is just a non sequitur. The point is that quality of service and products is not obvious in medicine, and it is simply impossible to know, except through statistical analysis, what really works and is safe. Consumers have a very flawed and hazy perception of the value of the health care products they buy.

    I am not sure exactly which of my assertions you are claiming is a non sequitur. However, I think you are probably refering to my claim that:

    I agree that consumers are making poor choices. However, that will change once people start inventing sure-fire treatments rather than treatments that are statistically likely to be beneficial.

    I didn’t go into my reasoning here, and I’d like to take a moment to flesh out my argument and show my work using the way syphilis has been treated through the ages. :)

    Initially nobody knew how to treat syphilis. Mercury (aka quicksilver) was an early form of treatment, but it was relatively ineffectual. As time went on, people came up with increasingly effective treatments down to the present use of modern antibiotics. Now, the early treatments, using malaria or primitive antibiotics might have been statistically likely to help, but from the perspective of an individual with syphilis, there was no certain way to treat or cure the disease. And, predictably, during that regime, syphilis sufferers were preyed upon by quacks selling bogus treatments so pervasively that the term quack is derived from the slang name given to quicksilver peddlers who sold ineffective cures to syphilis.

    When penicillin was found to consistently kill the bacteria that causes the disease the sensational news was publicised through the same channels that publish the sensational claims of the quacks. This resulted in a flood of anecdotal data that promoted the treatement that actually worked.

    Today, while there probably are a few guys selling quack treatments for syphilis, consumers largely ignore them; the fact that penicillin is guaranteed to ameliorate or cure the disease means that the quacks face an uphill battle. People aren’t scared of syphilis or enduring the sort of pain that makes them give a hearing to the quacks. The vast majority of the anecdotes they are exposed to are from people treated by penicillin succesfully.

    4) So – the quack claims will go away when we have completely cured everything? This may be true – but it’s irrelevant. We will likely never cure everything, if we do it is far enough in the future not to worry about, and when/if we do this entire argument will be irrelevant.
    So far it seems like there will always be new diseases and illnesses that are imperfectly treated. There has always been a vast gray zone of sub-optimally treated conditions. This is where the quacks prey. This is where regulation is most needed, to prevent exploitation and fraud.

    I agree with every single word you have written above.
    1)Just as Jesus said “You will always have the poor” I think we will always have delusional people/frauds selling bogus stuff – it’s a part of human nature. That doesn’t mean that I am a fan of quackery (even though I think they do provide a useful social function in addition to the harm they do). I merely accept that they inevitably exist.
    2)I agree that as we cure the currently problematic diseases/conditions, the result will be that rarer conditions that would go unnoticed will now become more prominent.
    3)Regulation cannot eliminate the quack, but can make it harder for them to get away with their fraud/delusional activities. However, there is no such thing as costless regulation. Regulations can cost more than the benefits they provide.
    Where we diverge is in the willingness to use coersion or violence to provide regulation. I am not a fan of coersive regulation for reasons that I would like to lay out:

    First there is the moral argument:
    To me, and I recognize I am stand pretty much alone on the board here, I am morally opposed to using violence to interfere with the actions of others that does not aggress against me. I may oppose my wife’s habit of wasting money on homeopathic nasal spray, but I have no moral right to beat up the owner of CVS for stocking it or to extort, via threats of kidnapping, the removal of those vials of ditilled water from the shelves. And lacking that right personally, nor can I hire an agent to do the deed for me. And since nobody else has that right either, it matters not how big a mob I get on my side, we still lack the moral right to use violence or threats of violence to get the manager of CVS to take the item of the shelves. Even if we are very numerous, and the bruisers we hire are wearing snappy blue uniforms and calling themselves “officer”.

    As the economist Ludwig von Mises argued:

    It is important to remember that government interference always means either violent action or the threat of such action. The funds that a government spends for whatever purposes are levied by taxation. And taxes are paid because the taxpayers are afraid of offering resistance to the tax gatherers. They know that any disobedience or resistance is hopeless. As long as this is the state of affairs, the government is able to collect the money that it wants to spend. Government is in the last resort the employment of armed men, of policemen, gendarmes, soldiers, prison guards, and hangmen. The essential feature of government is the enforcement of its decrees by beating, killing, and imprisoning. Those who are asking for more government interference are asking ultimately for more compulsion and less freedom.

    Second there is the utilitarian argument:
    Mises in that passage touches on the reason why I originally commented on this post: regulations are not costless!

    Non-governmental institutions can only acquire the resources they consume through peaceful production, trade, or donations. Thus, they are constantly evaluating the effectiveness of what they do.

    Governments, on the other hand, because they use threats of violence to fund themselves and can act with relative impunity, can pursue disastrous or wasteful endevours to unbeleivably distant ends. The NCCAM, for example, is a great example of this. Can you imagine the Howard Hughes Foundation wasting millions on the sort of research that NCCAM does? How about the Japanese version of the FDA that refused to approve birth control pills for women for decades? Would Consumers’ Union or the AMA have sat on its hands for so long?

    Moreover, the bad regulations can have terrifying consequences. Take a look at the DEA campaign against doctors who specialise in treating chronic pain sufferers. Any benefit to be acquired by making it harder for people to become addicted to opiates is overwhelmed in the face of the hundreds of thousands, if not millions who needlessly struggle with pain because the experts in the field are being being persecuted by moralizing yet ignorant crusaders.

    It’s tempting to look at the gray areas, or even the pretty black and white ones like the Christian Scientists who allow their children to die from treatable diseases and state that there oughta be a law.

    But we ignore the unintended consequences and the costs of laws at our peril.

    It’s not that eschewing violence (the so called radical “laissez-faire” position) produces a utopia where no snake oil salesman can ply his trade.

    Rather the state makes a bad situation worse because it imposes huge deadweight losses, is frequently hijacked by special interests who use it as an instrument of plunder, and semi-discriminately harms the innocent and guilty alike. And, no matter how powerfully the state attempts to supress the quacks, the quacks will still be able to ply their trade. Prohibitions rarely, if ever, work.

  19. Scott says:

    So is it then your argument that fraud in selling treatments that don’t work should simply be accepted and tolerated?

  20. tarran says:

    The notion that free markets only work if there is a symmetry of access to information between buyers and sellers is completely incorrect.

    That idea was originally advanced by some neoclassical economists as an assumption for a proof that free markets would work. I don’t think any major free market school currently advances that proposition, Nor have I ever encountered any convincing argument that in the absence of perfect information, free markets wouldnt’ work.

    To the contrary, if we look at the least regulated industry that we have day to day contact with, the software industry, one can see a continual improvement in the products available to consumers, falling prices desipite the fact that most consumers are wholly ignorant about how the software works and what it does.

    Moreover, nobody really thinks through the implications of claiming that markets don’t “work”.

    Since the market is really a matrix of transactions between actors, when an observer says “the market doesn’t work”, he’s claiming that he the transactions he observes are not conforming to what he desires to observe. Certainly the participants will think the the market to be working in that both parties are agreeing to a transaction because each one prefers their expected post-transaction condition to his expected condition in the absence of the transaction.

    If, as the neoclassicals assert, perfect information is required to make beneficial transactions, then the observer must have information that is perfect – including all the information that the actors posess.

    If the observer is to be a planner who controls the transactions, under the rubric that perfect information is required to make sensible decisions, then he needs access to all the information posessed by the individual actors. Hayek, Mises and Rothbard pretty much demonstrated that this is not possible.

    Thus, if perfect information were required for markets to work, then we’d all be still be living like animals (producing nothing and consuming only what we found in nature).

    No, people tend to figure out via experience or observation what works and what doesn’t. Through trial and error, people tend to make wiser and wiser choices over time. It doesn’t matter if the choices are being made by rubes who don’t know a speculum from a spatula or some highly educated solon – we still get the cycle of action -> experience -> learning driving improvements.

  21. Fifi says:

    There are also some very valid questions to be asked about how medicine can provide for some the needs that some “alternatives” do. I think this is particularly relevant to women’s health if we look at the studies being done on how women respond to stress (“tend and befriend” as different from “fight or flight”). There is clearly a “tend and befriend” aspect to many “alternative” therapeutic practices that is perhaps very important and useful in terms of treating conditions where stress can contribute to the worsening of symptoms and patient experience (such as chronic pain, many psychological disorders, etc). Combine this with the unfortunate tendency of some – not all but some – physicians to still minimize or attribute women’s complaints to being “hysterical” or “psychosomatic” (if we’re to use a more modern terminology) and you can see why simply being listened to and acknowledged in a caring way could be a beneficial component to treating many medical issues that have a psychological component. Health being an extremely personal issue that influences many aspects of a person’s self image and life, I doubt there are many people who don’t bring psychological and cultural baggage regarding health into the doctor’s office.

  22. tarran says:

    So is it then your argument that fraud in selling treatments that don’t work should simply be accepted and tolerated?

    No Scott, it’s not.

    My argument is that we should oppose them through
    1) Mechanisms that punish fraud.
    2) Getting better, workable products to market
    3) Refusing to promote them or via boycotts (for example not permitting them to work at a hospital)
    4) Public education.

    What I am opposed to is, for example, the state forbidding Post Cereal Co from putting claims about the healthfullness of cheerios on their boxes. I am opposed to using the state to regulate, in other words to premptively forbid voluntary transactions between willing participants.

  23. Scott says:

    The notion that free markets only work if there is a symmetry of access to information between buyers and sellers is completely incorrect.
    That idea was originally advanced by some neoclassical economists as an assumption for a proof that free markets would work. I don’t think any major free market school currently advances that proposition, Nor have I ever encountered any convincing argument that in the absence of perfect information, free markets wouldnt’ work.

    Not the argument I made. There need not be a symmetry of information, but when the buyers have NO information it fails quite badly.

    Since the market is really a matrix of transactions between actors, when an observer says “the market doesn’t work”, he’s claiming that he the transactions he observes are not conforming to what he desires to observe. Certainly the participants will think the the market to be working in that both parties are agreeing to a transaction because each one prefers their expected post-transaction condition to his expected condition in the absence of the transaction.

    Indeed, I consider it to be bad when quacks are permitted to perpetrate acts of fraud upon the public.

    My argument is that we should oppose them through
    1) Mechanisms that punish fraud.

    What I am opposed to is, for example, the state forbidding Post Cereal Co from putting claims about the healthfullness of cheerios on their boxes.

    Grossly inconsistent. You support mechanisms that punish fraud, but oppose forbidding fraudulent claims. You can’t have it both ways.

  24. Fifi says:

    tarran – “No, people tend to figure out via experience or observation what works and what doesn’t. Through trial and error, people tend to make wiser and wiser choices over time. It doesn’t matter if the choices are being made by rubes who don’t know a speculum from a spatula or some highly educated solon – we still get the cycle of action -> experience -> learning driving improvements.”

    Actually I don’t find this to be true at all since most people don’t understand that subjective experience and observation can lead to confirmation bias and how to actually take data on their experience in a way that does allow for some objectivity. If someone has an ideological attachment to a particular idea they tend to believe it works even when faced with evidence it doesn’t, is simply a placebo effect or they’re being conned. To be anecdotal – since you’re clearly into anecdotal “evidence” – a friend’s sister-in-law is dying of cancer. She’s at last stage bone cancer and has recently ended rather heroic traditional medical treatment – encouraged by her family but also chosen by herself. Even though her family was totally ripped off by a chiroquack earlier this year they’re still trying “alternative” methods. Once can entirely understand and have compassion for the urge to continue with heroic efforts and hold onto beliefs that emphasize spirituality (and being able to control the physical world with our thoughts) when faced with the reality of a painful and imminent death. Certainly many quacks and peddlers of potions take advantage of people in this situation, just as many people are vulnerable to seek miraculous cures and heroic efforts as last resorts.

  25. Scott says:

    No, people tend to figure out via experience or observation what works and what doesn’t. Through trial and error, people tend to make wiser and wiser choices over time. It doesn’t matter if the choices are being made by rubes who don’t know a speculum from a spatula or some highly educated solon – we still get the cycle of action -> experience -> learning driving improvements.

    Bleh, editing fail on my response to this bit.

    When it comes to medicine, this characterization is exceedingly overoptimistic. Trial and error, experience, and observation simply are not anywhere near adequate to evaluate medical treatments, no matter how well educated the individual in question is. It just doesn’t work. There is no learning.

  26. Dr Benway says:

    Through trial and error, people tend to make wiser and wiser choices over time.

    Ahem. Two thousand years of the humoral theory of disease. It just seemed to work.

    Can we afford a free market process of self-correction that takes that kind of time?

  27. qetzal says:

    tarran,

    Thanks for stimulating a very interesting discussion. I agree with many of your points, at least in principle, but perhaps disagree with how best to put them into practice.

    In particular, allow me to echo one of Scott’s points. How do you reconcile your support for “mechanisms to punish fraud” with your opposition to coercive government action?

    Why is it wrong for the state to prohibit Post’s claims about Cheerios? Because the claims don’t constitute fraud (as you would define it)? Because it’s coercive action by the state? (And if so, how else should fraud be punished?)

    Is there a point where you agree that coercive action by the state is justified in this area?

  28. Scott says:

    Because the claims don’t constitute fraud (as you would define it)?

    And just to give you fair warning, tarran, if you choose this option I’m going to object to that too. The claim is being made for the purpose of selling the product; it is not known to be true by the entity making it; it therefore qualifies as fraud in my book. Where I’m using the term ‘fraud’ in the ethical, rather than legal, sense – so the Quack Miranda Warning is irrelevant.

  29. windriven says:

    The exchange between Dr. Novella and tarran has been well reasoned and thought provoking. The ultimate question is who has the ultimate responsibility for one’s health. Is it the individual, the individual’s physician or the government?

    In the case of minors and those incompetent to render independent judgments or incapable of making their wishes known, it is clearly arguable that governments might intervene (and one would hope on the side of science-based medicine).

    But is it in our interest to allow the government to intervene in the health decisions of (arguably) mentally competent individuals regarding their own care? That suggests a very slippery slope indeed.

  30. “No, people tend to figure out via experience or observation what works and what doesn’t. Through trial and error, people tend to make wiser and wiser choices over time.”

    Bull, on many levels.

    This assumes people rationally analyze their outcomes and fully investigate all options and alternatives and also have the ability to qualitatively determine what is an error.

    If you have an understanding of human behavior, you should understand the various biases and logical fallacies that lead people to erroneous conclusions and do not lead them to wiser choices over time.

    On an individual level, choosing coffee enemas and herbal supplements over surgery and chemo/radiation for cancer may lead to death that would otherwise have been avoidable . How does the individual learn from that error and make wiser choices?

    For a society to collectively learn from trial and error to make wiser decisions in this context, the error in your trial and error is the unnecessary suffering and death of individuals, but at least it doesn’t infringe on the liberty of the fraud or quackster to make whatever claims they want in marketing whatever snake oil they please. Eventually the market will put those quacks out of business when they kill enough people, right? All hail the benign power of the perfectly free market.

  31. Citing the software industry as an example of the least regulated industries we have was an interesting choice. One of the reasons why we still have choices for platforms like Macintosh or browsers other than IE is that Microsoft is subject to anti-trust regulation.

  32. windriven says:

    Karl, it is an old – if logically flawed – device to spotlight an extreme example and then demolish it. Following your thread to its logical conclusion, I must be deprived of my free choice so that rubes (or perhaps just those who simply do not subscribe to the same orthodoxy as you) are protected from themselves. Good grief. Have we abandoned our free will? Become the assimilated into the Borg?

    I am a scientist by education and by personal philosophy. I am a skeptic, an atheist, and a true believer in the scientific method. But I also understand that science is the perfect arbiter of physical truth in much the same way that markets are the perfect arbiters of the values of goods and services; their perfection is achieved over time. Science is as susceptible to fashions as markets are to passions. Luckily, both always manage to correct themselves. There are scientific bubbles just like there are housing, stock or tulip futures bubbles. Truth is truth whether or not it is endorsed by this or that government. So I for one would prefer to make my own decisions about my healthcare rather than cede it to either Tom Harkin or Newt Gingrich.

    There is plenty of information about the idiocy of chiropractic, homeopathy, coffee enemas and magic amulets (thanks to Dr. Novella and all who toil with him in the fields of truth). Those (minors and mental incompetents excepted) who choose a coffee enema over erythromycin have had the opportunity to sift through the arguments for and against each therapy.

    The concept of caveat emptor has been a fixture of US jurisprudence for nearly 200 years. It serves a community by encouraging people to be wary consumers. There will always be those who choose the promise of a free lunch, a magic diet pill, a miracle cure that is being suppressed by big pharma. Also spracht Darwin (or if not Darwin, then at least Spencer).

    Government has a responsibility to assure that reasonable limits of truthfulness obtain in the marketplace. The rest is up to you and me.

  33. magra178 says:

    as a complete aside from the discussion going on here; do these bracelets have any relation to the bracelets some women wear during pregnancy to “relieve” morning sickness? I think those may have more to do with a pressure point on the wrist than magnets or copper, but I’ve always wondered. They were often briefly mentioned in the pregnancy books, and I didn’t have morning sickness so I didn’t have to worry about it. Just wondering what, if any, studies support their use.

    as always, I’m a fan of Dr. Hall’s comments.

    and someday I may quote Dr. Gorski’s Ayn Rand comment, I hope with permission.

  34. Harriet Hall says:

    magra178,

    The bracelets worn for nausea are intended to provide acupressure at the P6 acupuncture point. There are some studies that support it and others that don’t. As several reviews say “The evidence is mixed.” When there is mixed evidence and an implausible rationale, it is likely that the positive evidence is flawed for many of the reasons we have discussed on this blog. You can look for the studies yourself by going to PubMed and using search terms like pregnancy nausea acupressure and P6.

  35. windriven,
    That you can put out a rather lengthy statement espousing pure libertarianism and Austrian economics, and cap it off with the one liner, “Government has a responsibility to assure that reasonable limits of truthfulness obtain in the marketplace.” without explaining or reconciling that statement in the context of the rest of your statement is rather impressive slight of hand.

    Usually when we talk about the logical fallacy of argument from extreme consequences, we are talking about extreme probabilities and extreme outcome, not just extreme outcomes. Temporarily setting aside the desirability of the outcome being discussed, was what I described such a highly improbable outcome?

    My point was that the trial and error model for a group of people as a whole making wiser health care decisions has endpoints for individuals for which there is no ability for the individual to learn from. I don’t consider those endpoints to be necessarily extreme in regards to the probability of their occurrence.

    You reply implies that your position on this is, yes, some people will be ill-informed enough to make critical mistakes that lead to permanent, detrimental outcomes such as death, but it probably won’t be that many, and market forces are best for guiding the way over the long term, and we can’t let people not intelligent enough to educate themselves to get in the way of market forces, other than when the ambiguous “reasonable limits of truthfulness” apply.

  36. Dr Benway says:

    But is it in our interest to allow the government to intervene in the health decisions of (arguably) mentally competent individuals regarding their own care?

    “Competence” is task-specific. One may be competent to stand trial, but incompetent at reading French.

    Being well informed is part of being competent. But there are only so many hours in the day. It’s useful to delegate certain information duties to experts. But to whom?

    At the very least, if the public could clearly distinguish those who can do science competently and those who cannot, they’d know who is worth listening to and who is a waste of time. This might make it easier to usher in the Libertarian paradise.

  37. windriven says:

    Karl, it would appear that whatever disagreement we have hinges on the proper balance between government protecting agents from themselves and the freedom of agents to pursue their best interests as they see them.

    Your argument seems to be that some people are imperfect at recognizing their best interests and/or are inept at pursuing them and that therefore the government should have broad latitude in circumscribing people’s choices.

    My argument is that it is the consequences of these imperfections that benefit the community as a whole – that those who die from Legionella because they choose coffee enemas over erythromycin are object lessons to the rest of us. It is also my argument that many of those who write the laws that you would have constrain us are incompetent to the task at hand. Tom Harkin’s stand on funding faith healing is moronic. So too the various nut-jobs who gave us the Terry Schiavo debacle and prohibitions against stem cell research.

    And finally to the ad hominem, I confess to a more or less libertarian philosophy but I am certainly not an anarchist. Demanding a basic level of truthfulness in commerce is not a violation of libertarian principles. Ceding my right to be a dufus to Charlie ‘You Don’t Expect Me to Read, Do You?’ Rangel is.

  38. windriven,
    “Your argument seems to be that some people are imperfect at recognizing their best interests and/or are inept at pursuing them and that therefore the government should have broad latitude in circumscribing people’s choices.”

    You have either inferred my position incorrectly or are deliberately creating a straw man. I never advocated broad latitude for the government in circumscribing people’s choices.

    I don’t believe I made an ad hominem, unless you consider summing up a position as libertarian an ad hominem.

    I mentioned that your position seemed to me to be a fairly pure libertarian, laissez-faire philosophy because your end cap, “Government has a responsibility to assure that reasonable limits of truthfulness obtain in the marketplace.” seemed to be in conflict with that approach without some explanation of the degree and limits of that responsibility in light of your hands off, let the buyer beware philosophy.

    “Demanding a basic level of truthfulness in commerce is not a violation of libertarian principles”

    Demanding government be responsible for ensuring that truthfulness could be, depending on how you see the government executing that role. That’s why I asked for clarification.

  39. windriven says:

    Dr. Benway, what percentage of adult Americans do you believe confuse the competence of MDs with that of hydrotherapists?

  40. “It is also my argument that many of those who write the laws that you would have constrain us are incompetent to the task at hand”

    I’m not necessarily disagreeing with you, but free choice of the people put them there. Trial and error will weed them out of office eventually if they’re not good for us, right?

  41. Dr Benway says:

    Today’s quacks are MDs, windriven. Read Tim Kreider’s accounts of his med school.

    Over 40 of our top med schools have departments of “Integrative” Medicine.

  42. Dr Benway says:

    No shame in not noticing the above, windriven. The quackademic medicine movement only started in the mid-1990s –it’s quite recent. The IM departments happened around 2001 to the present.

    It’s the broken boundary between genuine science and pseudoscience within medicine that has a small number of MDs freaked out.

    Doctors don’t expect to stamp out quackery. The SBM doctors have a smaller, more reasonable objective: get it out of our medical schools.

  43. windriven says:

    Karl, nicely done. Our elected officials will give us a sausage casing stuffed with dollars for prayer cures, chiropractic, colon hydrotherapy, and 30 million newly insured competing for the services of primary care physicians that are too few in number now. You won’t be happy. I won’t be happy. And most of them will get re-elected. So much for free markets.

    Dr. Benway, so what is the answer? If woo can’t be eliminated from medical schools how can we even hope to have an educated body of medical consumers?

  44. Dr Benway says:

    Dr. Benway, so what is the answer? If woo can’t be eliminated from medical schools how can we even hope to have an educated body of medical consumers?

    Good question.

    Doctors are busy. They are largely apolitical and do not donate to PACs. They’re also terrified of lawyers and prefer to shun controversies. In short: MDs are cheese eating surrender monkeys unwilling to act against this quackademic invasion. “The five-dollar word is ‘pusillanimous’”

    I think we’ll need some help from our basic science colleagues if we want to stop this crazy train.

    There is a group called “DAN!” or “Defeat Autism Now!” They have another organization called the “Autism Research Institute.” They’ve established their own “board certification” in autism treatment.

    The DAN! doctors believe that autistic kids cannot robustly “detox” a variety of substances, and further, that their immune systems respond abnormally to vaccines and other environmental antigens. They posit that these kids have a “leaky gut” allowing antigens to enter the blood and so trigger a sub-clinical inflammatory reaction that affects a child’s behavior.

    The DAN! doctors prescribe a cereal bowl full of supplements for these poor children to take each day. They also restrict the children to a gluten-free/casein-free diet (no pizza!). And they recommend against vaccines.

    The DAN!s have no credible evidence to support their disease model or their therapies. So where do they get their ideas? Well, it’s easy to see a naturopathic theme – “toxins”, anti-vax, dietary obsessions. And there are several naturopaths and chiropractors involved with DAN!

    The DAN! doctors and their allies look quite respectable. Here’s one on the faculty of Harvard: http://www.marthaherbert.com/biography1.html

    Dr. Martha Herbert is an Assistant Professor of Neurology at Harvard Medical School, a Pediatric Neurologist at the Massachusetts General Hospital in Boston, a member of the MGH Center for Morphometric Analysis, and an affiliate of the Harvard-MIT-MGH Martinos Center for Biomedical Imaging. She is director of the TRANSCEND Research Program (Treatment Research and Neuroscience Evaluation of Neurodevelopmental Disorders).

    I don’t see how physicians –let alone the lay public– could smell any sort of rat there. I mean Jesus, Dr. Hebert’s on the teaching faculty of Man’s Greatest Hospital!

  45. tarran says:

    Interesting discussion. Unfortunately, I won’t be able to address all the concerns or rebuttals people have brought up in reaction to my assertions. I will, however, try to point people towards the writings of other or at least answer them at a high level.

    1) The overarching question that people ask is what I think the state should be doing. My answer is nothing. I started life as a Goldwater Conservative, and have, as I have, as a result of my studies of economics and history, become an anarchist.

    The rationale for eliminating the state are pretty forcefully laid out by the economist Murray Rothbard in “Anatomy of the State”.

    I reject the state out of principle, much like many of you would reject rape as a tool for enforcement of social order. No matter how “good” the desired service might be, the means is unacceptable.

    2) This does not mean that crimes go unpunished and that people are left helpless in the face of attacks. Far from it, there have been anarchic societies in human history, such as Iceland’s 300 years of anarchy in the middle ages and Pennsylvania in the late 17th early 18th centuries. While these places where no utopias, civil society thrived and the people living within them enjoyed a higher level prosperity and benefitted from a higher level of security than their contemporaries who lived under the rule of kings.

    3) Contra Karl Whitakay’s assertion, voters have an interest in voting in disastrous politicians in a democracy, just as elected politicians have an incentive to loot the economies their states parasitically feed off of.

    4) Historically anarchic regimes have tended to handle crimes not by punishment per se, but through demanding restitution to victims enforced via boycotts. Before you scoff at the notion of boycotts I recommend you read up on the psychologically devastating Amish custom of “shunning”.

    5) My definition of fraud is different than yours; I cannot judge someone guilty of fraud unless I can prove that they were a) making a claim that is demonstrably false (rather than merely unsubstantiated), and b) that they had malum mens rea, a guilty mind. Obviously there are nuances to quackery, I consider some forms of quackery to be non-crimes and others to be crimes. When I have more time, I will tackle this with a proper essay on the Liberty Papers.

    6) I am amazed that so many people on this blog are claiming unself-consciously that people are not capable of learning rationally from experience, while demonstrating that they, who are people, have learned how to look at statistics and skeptically evaluate claims. You guys realize that you are part of the human race, right? It’s not like the rest of the masses are untermenschen who are doomed to live in darkness without the the uplifiting rule of the uber-menschen.

    Yes, people are ignorant of much of what goes on in medical science. They are also pretty ignorant abot automotive technology too. Yet, somehow, the products in the market keep improving… Why? Because people who are ignorant try to find experts who tell them what to do. Of course, the experts may be good ones, or they may be the flim flam artists who make the most widely publicized, grandiose claims.

    Note, though, experience starts to prove the flim-flam artists wrong. That’s why they have to keep changing their schtick to get new suckers to buy their snake oil.

    7) Anybody who thinks that the anti-trust action against Microsoft is why we have a robsust and improving software industry has made a very serious error. Microsoft dominated the market because their stuff best satisfied consumer demand. And, as someone who used OS/2 Warp, OpenVMS, Unix, throughout the years of Microsoft’s dominance I find the claim that they had a monopoly quite risible. And, please note what has hapenned to MS over the past decade. They are a dying company because they now do a poor job of satisfying consumer demand.

    Over on Groklaw, every quarter or so, they publish a post decrying how the anti-trust measures against Microsoft lack teeth. In the meantime, Microsoft is going with its hat in its hand to PC manufacturers trying to avoid a recurrence of the Vista debacle since their sales are now dropping off.

  46. tarran says:

    Arrggh!

    I really should write my posts on an HTML editor so I can close the tags properly!

  47. Dr Benway says:

    I hesitate to join any libertarian discussion at SBM, as it tends to result in overly long posts that bore people here for medicine rather than politics. But…

    I can’t resist saying that I see little difference between “state” and other groups that humans create to fulfill some need. Medicare is a bitch to deal with. But BC/BS does not satisfy either.

  48. Dr Benway says:

    I cannot judge someone guilty of fraud unless I can prove that they were a) making a claim that is demonstrably false (rather than merely unsubstantiated), and b) that they had malum mens rea, a guilty mind.

    In a civil complaint it’s often enough to show that a defendant should have known his claim was false.

  49. tarran says:

    Dr Benway,

    It’s a risk I run with my comments -> I tend to comment only on the areas where I feel I can contribute, namely economics and political theory, and inevitably that means that I am playing with fire; threadjacking is frowned upon here. :)

    Certainly I don’t want to divert attention away from the main points of Dr Novella’s post, namely the lack of therapeutic effect of the bracelets.

    BTW, and this is my last comment of the day (calculus exams don’t grade themselves, unfortunately) there is a big difference between a medical mutual and the government.

    You can opt out of an agreement with a company. The government, not so much. They have guns. Search for “Ludwig von Mises” above on this page for a more fleshed out argument. ;)

  50. Dr Benway says:

    Yes I know about the guns. But any vendor big enough can also become coercive.

    I feel the emphasis on “state=bad” misses a more fundamental and relevant problem: how to hold any powerful organization –private or public– accountable to the public good.

  51. Scott says:

    6) I am amazed that so many people on this blog are claiming unself-consciously that people are not capable of learning rationally from experience, while demonstrating that they, who are people, have learned how to look at statistics and skeptically evaluate claims. You guys realize that you are part of the human race, right? It’s not like the rest of the masses are untermenschen who are doomed to live in darkness without the the uplifiting rule of the uber-menschen.

    You’re missing a crucial and fundamental point. That being the fact that medical claims CANNOT be meaningfully evaluated on the basis of personal experience. They can ONLY be evaluated based on careful statistics and large studies.

    As a result, without those statistics and studies, it is quite impossible to determine which products are superior. And even when they are available, evaluating them is costly – both in terms of expertise required and in terms of the time required even if one HAS the expertise. For this reason, relying on individual evaluations is completely ludicrous – it simply can’t be done.

    This is *quite* unlike any of the counterexamples you’ve listed. With cars, for instance, individuals are entirely capable of determining how well their car worked for them. Hence, a supposed expert whose claims are false is quickly debunked.

    But with medicine, there is no way an individual can tell whether the expert’s advice was good or not. Thus experience most emphatically does NOT “prove the flim-flam artists wrong.”

    It’s quite illustrative to note that the quacks DON’T have to keep moving on and changing their schtick. Acupuncture, chiropractic – heck, reiki – continue to GROW in popularity! Thus your rosy picture of what will happen to them is empirically proven false.

  52. windriven says:

    @ Dr. Benway re: tarran
    Libertarians are not saying that government=bad, only that government does not automatically equal good. In these pages and others we hold corporate actors to account for their misrepresentations. Government though generally gets a pass. What’s up with that?

    If you take a moment to review governmental actions like the income tax, social security, and – in many States – legalized ‘gaming’ you will find bait and switch, sleight of hand, and outright lies that would make the basest snake oil pitchman blush.

    Nearly everyone understands that the current health care delivery system needs to be reformed. But this is a hugely complex problem riddled with technical and financial arcana. The sad truth is that among those least prepared to untangle this mess are most members of Congress, a body not well known for its dispassionate and careful analysis nor, for that matter, its management of unintended consequences.

  53. windriven – I think if you look through our posts you will see that government in no way gets a pass.

    And, while SBM is politically neutral, and we try to keep our posts as unbiased as possible, I happen to know that the authors who publish here span the political spectrum and include libertarians.

    The problem with tarran’s position is that he is assuming, without justification, that government regulation is always a net negative and free markets a net positive. He has not really addressed the major objections to his position – that end users of medical product simply cannot judge their health effects. This is not due to stupidity or any deficit – it’s just impossible for individuals to distinguish anecdotaly net health effects from placebo effects and a host of psychological effects, like confirmation bias and regression to the mean. Add to that the technical complexity of understanding biomedical research and the psychological effects of being ill and perhaps even desperate. Further, helpful research costs millions and there is simply no mechanism for private entities to make such investments unless they are forced to.

    This is, in fact, what has actually happened historically. Arguing that something different will happen in the future if we just further cut back on government intervention is nothing short of magical thinking.

  54. David Gorski says:

    This is, in fact, what has actually happened historically. Arguing that something different will happen in the future if we just further cut back on government intervention is nothing short of magical thinking.

    Indeed, but such is the nature of libertarianism. It’s just as magical thinking as when certain liberals think that everything will be all better if we passed a new law and regulated things. As in everything in life, it’s shades of gray. It’s a balancing act, and the difficulty is finding the “sweet spot” between too much regulation and too much unbridled free market.

  55. “As in everything in life, it’s shades of gray.”

    Indeed, I sometimes say the world is more complicated than even shades of gray, since that implies only two possible extremes with an infinitely variable middle, and the universe is really an infinite palette of colors with all sorts of extreme positions.

    Libertarians, Republicans, Democrats, Communists, Fascists, etc…

    In many things, it is often best and wisest to avoid the extremes.

  56. The above was not meant to imply that all Libertarians, Republicans, Democrats, Communists, Fascists, etc are extremists, but rather that each philosophy has one or more of its own extreme versions, distinct form the other philosophies such that the “gray middle” is relative to more than just two endpoints..

  57. windriven says:

    Dr. Novella, my comment on government largely getting a pass was aimed more at the skeptical movement in general than at SBM specifically. And I really hadn’t intended to wander off into the political weeds anyway. But there is, I think, an important question to be asked: shall people in a free society have the right to do stupid things? From that immediately follows the question: shall people in a free society be allowed to believe stupid things? There is an event horizon somewhere there beyond which lie frightening things.

    It is easy to yield to the impulse to have government stamp out stupidity. Unfortunately, government is as often the merchant of stupidity as the slayer. Spend a few moments at a Texas school board meeting or reading currently proposed health care legislation for ample proof.

  58. qetzal says:

    windriven,

    IMO, people in a free society should indeed be free to believe and do stupid things, so long as those things really only affect themselves.

    That’s not really the issue with things like copper & magnetic bracelets, though. Rather, the issue is whether people should be free to make misleading or outright false statements to dupe others out of their money.

  59. windriven says:

    qetzal, agreed on copper and magnetic bracelets and every other pile of woo. You are referring to the last of a long series of posts. Not sure how it ended up as a political exchange. In any event, no argument about false and misleading statements. But if you say, “…there are many who believe that magnetic bracelets reduce joint pain…” and some adult buys a bracelet from you, I would argue that a legal transaction has occurred.

  60. qetzal says:

    I agree. Said adult is being a bit foolish, but that shouldn’t be illegal.

  61. magra178 says:

    thanks for the information Dr. Hall.

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